Importance Preventing unwanted pregnancy through adequate use of contraceptives among adolescent girls is essential for improving maternal and child health and social well-being. Objective To estimate the levels and trends of contraceptive use in adolescent girls (age 15-19 years) compared with adult women (age 20-34 years). Design, Setting, and Participants This survey study used data from 261 Demographic and Health Surveys or Multiple Cluster Indicator Surveys conducted in 103 low- and middle-income countries between 2000 and 2017. Modern contraceptive use in 90 countries and unmet need for family planning in 73 countries for adolescent girls and adult women were assessed at country and aggregate levels. Data analyses for this study were conducted between March 2019 and December 2019. Main Outcomes and Measures Modern contraceptive use and unmet need for family planning, estimated between adolescent girls and adult women for absolute inequality and relative inequality (defined as the ratio in service use beong adolescents. Thus, inequality increased from 7.7 PPs (95% CI, 7.2 to 8.2 PPs) in 2006 to 34.7 PPs (95% CI, 34.2 to 35.1 PPs) in 2015. Conclusions and Relevance Despite a growing focus on contraception in the past decade with initiatives such as Family Planning 2020, adolescent girls continue to lag behind adult women in contraceptive use. There is a pressing need to develop age-appropriate strategies for increasing access and maintaining contraceptive use in sexually active adolescent girls.Importance Online patient portals support self-management, and mobile devices expand portal access, but whether this translates to improvements in diabetes outcomes is unclear. Objective To examine the association of adding mobile patient portal access with diabetes medication adherence and glycemic levels among adults with diabetes. Design, Setting, and Participants This retrospective cohort study included patients with diabetes treated at Kaiser Permanente Northern California, a large, integrated health care delivery system, from April 1, 2015, to December 31, 2017. Inclusion criteria were adults with diabetes with an oral diabetes prescription at baseline and no insulin use. Data were analyzed from March 2018 to March 2019. Exposures Patient portal access status for each calendar month from April 2015 to December 2017, categorized as never used, used from a computer only, used from a mobile device only, or used from both computer and mobile device. Main Outcomes and Measures Medication adherence, measured 13 (95% CI, -0.16 to -0.10) percentage points in HbA1c level. Among patients with higher baseline HbA1c level (&gt;8.0%), changing from no portal access to both computer and mobile access was associated with an increase in PDC of 5.09 (95% CI, 3.78 to 6.40) percentage points and a change of -0.19 (95% CI, -0.27 to -0.15) percentage points in HbA1c level. Conclusions and Relevance These findings suggest that providing patients with computer patient portal access and combining it with mobile patient portal access are associated with significantly improved diabetes medication adherence and glycemic control, with greater benefits among patients with more clinical need. Convenient access to portal self-management tools through a mobile device could significantly improve diabetes management.Importance Despite improvements in antenatal care and increasing cesarean delivery rates, birth asphyxia leading to neonatal encephalopathy (NE) continues to contribute to neonatal death and long-term neurodevelopmental disability. Cardiotocography (CTG) has been used in labor for several decades to detect a stressed fetus so that delivery can be expedited and NE avoided. Objective To investigate whether experienced clinicians can detect and respond to abnormal readings from CTGs during the penultimate hour before birth in infants with moderate to severe NE but no acute peripartum event. Design, Setting, and Participants This case-control study included 10 practicing obstetricians and midwives at maternity hospitals in New Zealand. Participants, who were masked to the perinatal outcome, were asked to assess CTG tracings from 35 neonates with NE and evidence of birth hypoxia (ie, cases) and 105 neonates without NE or birth hypoxia (ie, controls), all of whom were born in 2010 to 2011. Data analysis was conductrange) specificity of 67% (53%-77%) and 87% (65%-99%), respectively. A sensitivity analysis including only assessors with 80% or more interassessor agreement only differed from the main analysis by 6% or less (mean [range] sensitivity for detection, 76% [63%-91%]; sensitivity for action plan, 36% [25%-49%]; specificity for detection, 71% [53%-77%]; and specificity for action plan, 93% [88%-99%]). Conclusions and Relevance Experienced clinicians detected 3 of 4 infants who were subsequently diagnosed with NE. Action to expedite delivery was recommended for more than 40% of infants with NE. These results indicate that CTG does not identify all infants at risk of NE, and that there is a need for further investment in new approaches to fetal surveillance in labor.Importance Less than half of US patients with a diagnosis of atrial fibrillation (AF) receive oral anticoagulation. Objectives To identify patients with similar patterns of adherence to regimens of warfarin and direct oral anticoagulants (DOACs) in the first year after AF diagnosis and to evaluate associations between patient characteristics and membership in latent classes of adherence. Design, Setting, and Participants This retrospective cohort study used 2013 to 2016 Medicare claims data to identify 7491 patients with a new diagnosis of AF in 2014 to 2015 who initiated warfarin after AF diagnosis and 9478 patients with a new diagnosis of AF in 2014 to 2015 who initiated DOAC treatment after AF diagnosis, for a total of 16?969 Medicare beneficiaries. Participants were followed up for 12 months after AF diagnosis. Statistical analysis was performed from February 1 to November 30, 2018. https://www.selleckchem.com/products/itacnosertib.html Exposures Treatment with warfarin or DOAC after AF diagnosis. Main Outcomes and Measures The main outcome was the proportion of days that patients received warfarin or DOAC, measured in 30-day intervals after AF diagnosis.